HomeMy WebLinkAboutPermit Sewer Connection Record 1980-9-18
I IrISPECTIOll L11/E
726,3769
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INFDRlIATION UNt
726-3753
Sq. Ftg. 1.lain
!:q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter ~ep.
Fence_Demo _Change/Use
Other
CITY UF SPRIrIGFIElD
COII6I;/ATION APPLlCATION/PERMlT
EilERGY SOURCES:
Heat
Hater Heater
Job Address
5(P Du>_Ma.\C'\ So\-.
legal Description Tht.\r5~"f\ ~\a.20.. ShOpS
Owner
Address
Construction lender
Address
U,SIGlI TEAll
Primary
Structural
Electrical
t1echan; ca 1
CONTRACTORS
fnilfllel
{name 1
Genera 1
Me.\ Ii CoC'\s~(".
r ho.se Ce.
Plumbina
, Electrical
. J ':echanic.al
PlUII6II/G
1.'10.
Each single fixture
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I I Temporary Construction;
I I Cha~ge in existing
_n__'_._ Le.5..l1fD~__., . _ _..__
I multifamil/. camm. or.
Tndustrial
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FEF (H/l,Rr;F
Relocated buildino
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1. bath) each
Additional bath
~!ater service
Sewer
Istorm Sewer
~S\C
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/ D~ I TOTAL CHARGES
tha t tile El eetr; Cd 1 work. be done by an
label has been signed by an Electrical
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40
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I TOTAL CHARGES
WHERE STATE l.\1i REQUIRES
shall not be valiJ until the
cf)
18
Range
Value of Hark:
Phone
Buil'tino Permit Info: Oescr be \-1ork(Le.. Build Single
Familv r-esidence Hith JI..ttached Garaoel "
./"
----
s.o.u .~..r -r uJ o....-t::Qr
IDLe
Phone
(iiddress)
I
(phone no.)
(l ics. no.)
(exlJ;res)
<k
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"
(phonF> n~- -- l~
. r
~ 85-/l..J 17 !
l1)'lD- I '18/ ~
r.
ro
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. ~
,
"
~F~ I rl-tARiojj
(address) (lieso noo)
16 Va.C'\ 1JLI('Pt""\
~C.'!.oY' ~c:." Of
(exoi i-es l
ELECTRICAL
MECHAN I C,\l
~I('\
~. ~~~ rl-tnRr,~ NO_
Residence of
SQ. FT.f
furnace/burner to
BTU's
.~, I
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wa 11
So~rp he~tpr ~nd vpnt.
Of
I COI11-I./IND. FEEDERS
Install/aIter/relocate
tjio;tril, fppdpro;
App1 iance vent
<;poarate
Stationarv evao.
cooler W .
Vent fan with
sinole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood nnd duc.t.
Wood stove/heater
'D
!,
amps,
Of
amps.
ISSUANcr OF PFRllIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit~,
Surervisor and returned to the Building Division
I HAVE CAREFULLY EX/VlINED t~e completed apDlication for permit, and do hereby certify that all information hereon is true
-~nd correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City.
-of Springfield and the la\-ls of the State of OreC]on pertaining to the work described herein, and that 110 OCCUPAIKY will be made
'Jf any structure without the permission of the Building Division. I further certify that my registration with the Builder's
.~oard is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption ;s noted hereon, and that
IJn1y subcontractors and emDloyees who are in com~liance with ORS 701.055 will be used on this 9roject.
I.lAI.IE(pIease print)
I
C\-.a~ ~ - r~nr\'fnE' l.JciClh!JOII.~TURE ~ '\..)~ D^TE1:.(&~M
: ~one
I -ire Zone
I-load Plain
BUILDING PERMIT
Charges anc
Surcharges
. PcU!1BING PERMIT
CharOges and
SurCharges
ELECTRIC~.L PERI~IT
Charges and
Surcharges
"[CHAtI!CAL PERI1IT
Charges and
Surcharl)es
-
FOr:OFFICE IISE O,ll Y
Tyoe/Const. Units Sq.' Ftg. riain
Bedrooms Occy Load Sq. Ft!J. Access
Stories Occy Group Sg. Ftg. Other
, I Plan Ck.
____________ 65VB1da
I Plan Ck.
.30%/Bldn
10.00 I Fence
------,-40---1 D~mo
I Sidewal k
A/C Paving
__h________,_
x Value
x Value
x Value
TOTAL VALUATlOII
Comm/Ind
Per Fee
Res
Ppr Fp.p'
'Systems Development
Charqe (1.5%)
Total Comb. rermit
Curb Cut
TOTAL
IO.CJ.Q
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I. Applicant to furnish
A. Job Address
B. legal Description
1. examDle- Tax Lot 100. Lane County f'lap Re' to\.
11 U3 43 \
2. examole- Lot 1. Block 3. 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forcE
2. exasnJe- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. - r-
1. examole- 1250 sq. foot house. 500 sq. foo ~r'
2. examole- if new project. check-new - if a
check add, etc::.
F. Building permit information: 1 r
1. example - construct single family house- 0 ~r
ettached gar~ge '
2. examole - remodel existing garage into far
3. examole - convert sir:gle family residence (
restaurant (Change of use) .
G. Value of work as defined in Section 303 (a) 9f
Structural Specialty Code
H. DESIG:I n)..;',l Aij~ COnTRACTORS
To avoid dEsign or construction delays, 811ildi (
Division Staff must be able to contact appro0r
persons regarding design information or job $)
corrections. etc.
Abbreviated Plu;;:bing, ;'lechanical, & Electrical Schl
A. Exc~~t l'lhere blank S:Jilces occur in the descrip~
Portion of the Mech~llical and Electrical Schedl
th~ applicant need :'"ill-in only the 1-10. Boxes ~ .r'
to tne aopropriate itcm(s) to be installed \
B. Full Plu~bing. ;'lechanical, and Electrical Schec
are available at the Building Division .
1. To conserve space on the permit form the,sc (.
have been abbreviated
2. !f. the item(s) to be installed are not cove
the a bbrev 1 a ted schedu 1 es you s hou 1 d consu 1
full schedules
C. BUllDI::G DI'IlSIQ;1 STAFF WILL FILL OUT ALL FEES, (
CHARGES 0:1 THE SCHEDULES
O. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
~h~~2~rr ~G~~i~~~. t1,~ ~nit~~i ap~lic~tion wil i be J
a worksheet only. Where possible, Building Division {f',
wl11 preoare a type IoWl tten copy and return it to th BY (I
applicant at the time the actual permit is issued fo
signature.
fees and Charges (
Plan cncck fees drc due arid payable at the time of tl .
application. Jnd no plans will be processed until thE+-
fees are paid. ~Jl other fees and charges are due and'
payable wnen the permit is issued.
!''lO~,;t'",,,,,;,'''''"'';'4!l..
'f4:' , .. -'1:"
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COMBINATION APPllCATION/PERMIT (CAP)
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be delivere(
by his elect
is not auth(
III.
IV.
V. FO" OFFICE USE G::P
"'1M'pr'lF""-~1, -. .',
'.... ,,', '. Ji,,,'':1-,,''j~-;
.f'''"S",of
~..14 _t.
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PERMIT VALIDATION
CITY
SPRINGFIELD
(
OF
c
City Hall
Springfield. Oregan
Department af Public Works
OFFICIAL RECEIPT
No., B
Date q- ICO 1S0
Rec'd F (' \"'\0 ,~Q 01')1'"'11 (lil.1A-0{
ram / A-CSqq I \j
Address PO Bw 6
- - -----... (~,
54 61. 6 "
(I
Received For:
!]
Yi )J(Y! bin 0
/ < \. J[)llk )f'rl..( j- J
~e - 1 A.~ ~
'1 ,L/
I(),DO
,'10
(~
.~!.
{if
.~
~.
ID,40
~.
~d Amount R~ceived
~
IJ ~'
(/I
AUT ORIZEO SIGN"TURE
S"E~TO".T\J"N"U~~ "~'NTE~" . €UG€"€. 0" .,.0'
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B8~"'8 \..
Permit Clerk
!
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"...,..........._ I.....
Pemit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
>
PLANS REVIEWED BY:
Ii... ~_, .' . . ."" .
name
signature
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date
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